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Arrhythmia

  • An arrhythmia (also called dysrhythmia) is an abnormal rhythm of the heart, which can cause the heart to pump less effectively. It:

    • many occur in people who don’t have underlying heart disease
    • occurs more frequently in adults
    • can be classified as slow (bradyarrhythmia) or fast (tachyarrhythmia)

    How Boston Children’s Hospital approaches arrhythmias

    The Electrophysiology Service at Children’s specializes in diagnosing and treating heart arrhythmias in kids and young adults. Our program is one of the largest and most experienced in the country and we treat more patients with congenital heart problems than any other hospital in the world. We perform more than 400 electrophysiology procedures annually.

  • What is an arrhythmia?

    Almost all heart tissue is capable of starting a heartbeat, or becoming the "pacemaker.” An arrhythmia may occur when the heart's natural pacemaker (the sinus node) develops an abnormal rate or rhythm.

    Some arrhythmias are benign (not dangerous), while others may be life threatening. There are different ways of classifying arrhythmias, which can be described based on where within the heart the arrhythmia originates (that is, in the atria or top chambers of the heart, or in the ventricles or bottom chambers of the heart), or whether the arrhythmia is related to the heart beat being too fast (tachyarrhythmia), too slow (bradyarrhythmia), and whether the beat is regular or irregular (fibrillation).

    What is an atrial arrhythmia?

    An atrial arrhythmia isan abnormality that occurs in one of the two upper chambers of the heart, the left or right atrium. It is causedby abnormal function of the sinus node or the atrioventricular node.

    Types atrial arrhythmias include:

    • sinus arrhythmia
      • heart rate varies with breathing
      • commonly found in children
      • usually a benign condition
      • typically no associated symptoms or problems
    • sinus tachycardia
      • heart rate is faster than normal
      • may cause symptoms such as weakness, fatigue, dizziness or palpitations
      • often temporary, occurring when the body is under stress from exercise, strong emotions, fever or dehydration
      • Once the stress is removed, the heart rate will return to its usual rate.
    • sick sinus syndrome
      • sinus node sends out electrical signals either too slowly or too fast
    • premature supraventricular contractions
      • also called premature atrial contractions (PAC)
      • sinus node or another pacemaker site above the ventricles sends out an electrical signal early
    • supraventricular tachycardia (SVT)
      • also called paroxysmal atrial tachycardia (PAT)
      • heart rate speeds up due to a series of early beats from the sinus node or another pacemaker site above the ventricles
      • may cause symptoms such as weakness, fatigue, dizziness, fainting or palpitations if the heart rate becomes too fast.
    • atrial flutter
      • electrical signals come from the atria at a fast but regular rate, causing the ventricles to contract faster and increase the heart rate
    • atrial fibrillation
      • electrical signals come from the atria at a very fast and erratic rate

    What is a ventricular arrhythmia?

    A ventricular arrhythmia occurs in the two lower chambers of the heart called the ventricles. It is caused by an interruption in the electrical conduction pathways, or the development of another area within the heart tissue that takes over the function of the sinus node.

    Types ventricular arrhythmias include:

    • Premature ventricular contractions (PVCs)
      • Electrical signal originates in the ventricles and causes the ventricles to contract before receiving the electrical signal from the atria.
      • They are common and often don’t cause symptoms or problems.
      • In some cases, they may cause symptoms such as weakness, fatigue, dizziness, fainting or palpitations.
    • Ventricular tachycardia (VT)
      • Life-threatening condition where an electrical signal is sent from the ventricles at a very fast but even rate.
      • It may cause symptoms such as weakness, fatigue, dizziness, fainting or palpitations.
    • Ventricular fibrillation (VF)
      • An electrical signal is sent from the ventricles at a very fast and erratic rate.
      • It may cause very low blood pressure and symptoms such as weakness, dizziness, fainting or loss of consciousness.
      • A person in VT may require an electric shock or medications to convert the rhythm to back normal sinus rhythm.

    What does a heart arrhythmia mean for my child?

    Arrhythmias, or irregular heartbeats, can cause problems with contractions of the heart chambers. This can show up in two ways:

    • not allowing the chambers to fill with an adequate amount of blood
    • not allowing a sufficient amount of blood to be pumped out to the body

    What are the symptoms of arrhythmia?

    The following are some common symptoms of arrhythmia:

  • How are arrhythmias diagnosed?

    In addition to a complete medical history and physical examination, there are several different types of procedures that may be used to diagnose arrhythmias, including:

  • Arrhythmias may be present but cause few, if any, problems. In some cases, your child's physician may choose not to treat the arrhythmia. However, when the arrhythmia causes symptoms, there are several options for treatment.

    Treatments may include:

    • lifestyle modifications
      • factors such as stress, caffeine, or alcohol can provoke arrhythmias
    • medication
      • will be determined by the type of arrhythmia, other conditions which may be present, and other medications already being used by your child.
    • cardioversion
      • small, electrical shock is delivered to the heart through the chest to stop certain fast arrhythmias such as atrial fibrillation, supraventricular tachycardia or atrial flutter
    • ablation
      • invasive procedure done in the electrophysiology laboratory, and involves inserting a small, thin tube catheter (a very thin, flexible hollow tube) into the heart through a vessel in the groin or arm. Then using radiofrequency ablation (very high frequency radio waves that heat the tissue until the site is destroyed) or cryoablation (an ultra-cold substance that freezes the tissue and destroys the site), the site of the arrhythmia may be destroyed.
    • pacemaker
      • small device is implanted under the skin and sends electrical signals to start or regulate a slow heartbeat
    • implantable cardioverter defibrillator (ICD)
      • small device, similar to a pacemaker, is implanted under the skin, often in the shoulder area just under the collarbone. An ICD senses the rate of the heartbeat. When the heart rate exceeds a rate programmed into the device, it delivers a small, electrical shock to the heart to slow the heart rate. Newer ICDs are combined with a pacemaker to deliver an electrical signal to regulate a heart rate that is too slow. ICDs are used for life-threatening fast arrhythmias such as ventricular tachycardia or ventricular fibrillation.
    • surgery
      • usually done only when all other options have failed. Surgical ablation is a major surgical procedure requiring general anesthesia. The chest is opened, exposing the heart. The site of the arrhythmia is located, then destroyed or removed.
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